Brief · Use case · Market Access

Pricing and Contracting Position.

LiveDecision Memo

Decide between a list price, a lower price and an outcomes-based agreement, scored on net revenue, speed of access, cross-market precedent and administrative burden.

DeciderGlobal pricing committee

Needed by1 September 2027

Positions scored3

Criteria5

ExpertGlobal Pricing Lead

LengthStandard

Pricing and Contracting Position is a ready-made use case for Market Access. It ships under the Decision Memo template.

For pricing and market-access leads preparing a negotiation position. You get a recommended position, a scored comparison of the contract shapes, the precedent risk in other markets, and what would change the answer. Reference prices and precedents are cited to public sources or marked as gaps.

Add it to your library to reuse from New → From template. Edit the saved copy in your library on the service form.

The decision

What pricing and contracting position should a new therapy take in one European market: a list price with no contract, a lower list price, or an outcomes-based agreement with a rebate? The memo also scores accepting the payer’s first offer.

The three positions on the table

Each position trades net revenue against speed, precedent and effort. The memo scores them, and the payer’s first offer, on the same five criteria.

Route	What it asks of you	It fits when	What the payer will weigh
List price, no contract	Take a single price to the payer with no rebate and no link to outcomes.	The payer already sees the price as justified by the evidence, and you do not need to trade price for speed.	Whether the payer accepts the price on the evidence alone
Lower list price	Accept a lower public price in this market to speed access. Governments can benchmark a medicine’s price against its price in other countries, so a public price here can travel.^{1World Health Organization. WHO guideline on country pharmaceutical pricing policies, second edition. Announced 28 September 2020.}	Speed of access matters more than price, or the market is small and few other markets reference it.	Net revenue given up, and which markets would reference this price
Outcomes-based agreement with a rebate	Tie payment to outcomes tracked in a defined patient group over a set period. Collecting the evidence is costly, and negotiation, monitoring and evaluation costs can be substantial.^{3Garrison, L. P. Jr, Towse, A., Briggs, A. et al. Performance-based risk-sharing arrangements: good practices for design, implementation, and evaluation. Report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force. Value in Health, 2013;16(5):703–719.,4Wenzl, M. and Chapman, S. Performance-based managed entry agreements for new medicines in OECD countries and EU member states: how they work and possible improvements going forward. OECD Health Working Paper No. 115, 2019.}	The payer’s barrier is uncertainty about effectiveness at launch, and the outcomes can be measured at a cost both sides will carry.	Who measures the outcome, how, over what period, and what triggers the rebate

What the memo does with them

Net revenue, not list price. The memo compares the three positions on what you would receive after rebates, not on the headline price. Every price, rebate and volume assumption is cited or labeled as an assumption, and nothing is carried over from another product.

Precedent risk made visible. Governments can derive a benchmark for a price from what the same product costs elsewhere. The memo lists the markets that reference this one and says what a lower price here would do there, or marks it as a gap where no source says so.^{1World Health Organization. WHO guideline on country pharmaceutical pricing policies, second edition. Announced 28 September 2020.}

The clock. Under EU rules, authorities must decide on a price within 90 days of a complete application, and on inclusion in health insurance within a further 90 days, or within 180 days when the two are handled together. The memo applies the national timeline where it is known and marks it as a gap where it is not.^{2Council of the European Communities. Council Directive 89/105/EEC of 21 December 1988 relating to the transparency of measures regulating the prices of medicinal products for human use and their inclusion in the scope of national health insurance systems.}

Whether an outcomes-based agreement is worth its cost. The task force that set out good practice for these agreements found that the cost of evidence, negotiation and monitoring can undo the benefit, that the study design has to match the uncertainty being addressed, and that governance matters. The memo tests your agreement against those points.^{3Garrison, L. P. Jr, Towse, A., Briggs, A. et al. Performance-based risk-sharing arrangements: good practices for design, implementation, and evaluation. Report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force. Value in Health, 2013;16(5):703–719.}

Five criteria, scored the same way. Net revenue, speed of access, precedent risk across other markets, payer acceptability and administrative burden. Accepting the payer’s first offer is scored too. The scores are analyst judgment, labeled as such.

How it could fail. The pre-mortem probes the failures this decision invites: a price that spreads to markets you meant to protect, an outcomes agreement that costs more to run than it returns, a payer who counters below your floor, or a negotiation that outlasts the launch window. Each gets an early warning and an owner.

Recommended length

Standard

The position will be revised as the negotiation moves, so the decision is reversible in stages. Standard gives the options, the reasons and the precedent risk in about 1,700 words.

You can pick another length on the form. The other two stay available.

Assumptions the memo tests

A Comprehensive memo lists the assumptions that carry the answer, each with a test and a date. A Standard memo carries the main ones in its section on what would change the answer. Examples for this decision:

The payer’s first offer is not its final position.
The markets that reference this price are the ones the memo lists, and no others.
The outcome an agreement would track can be measured from data that already exist, at a cost both sides accept.
The national timeline leaves room for a second round of negotiation before launch.

Standards, guidance and sources

Pricing policy

The WHO guideline on country pharmaceutical pricing policies, 2020: it covers ten pricing policies, including benchmarking a price against other countries.^{1World Health Organization. WHO guideline on country pharmaceutical pricing policies, second edition. Announced 28 September 2020.}
Council Directive 89/105/EEC on the transparency of national measures that set medicine prices and decide insurance coverage: 90-day and 180-day limits on national decisions.^{2Council of the European Communities. Council Directive 89/105/EEC of 21 December 1988 relating to the transparency of measures regulating the prices of medicinal products for human use and their inclusion in the scope of national health insurance systems.}

Contract design

ISPOR good practices for performance-based risk-sharing arrangements: how to design, implement and evaluate an agreement that links payment to outcomes.^{3Garrison, L. P. Jr, Towse, A., Briggs, A. et al. Performance-based risk-sharing arrangements: good practices for design, implementation, and evaluation. Report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force. Value in Health, 2013;16(5):703–719.}
The OECD review of performance-based managed entry agreements for new medicines in OECD countries and EU member states, 2019.^{4Wenzl, M. and Chapman, S. Performance-based managed entry agreements for new medicines in OECD countries and EU member states: how they work and possible improvements going forward. OECD Health Working Paper No. 115, 2019.}

The decision practice behind the memo itself is on the template page.

What gets flagged

Any reference price or precedent without a public source, the markets where a lower price would spread, the administrative cost of an outcomes-based contract, and the assumption about the payer’s first offer.

What arrives

Decision requested
Recommendation
Context and framing
Options considered
Why this option wins
What must be true
What would change the answer
Risks and the pre-mortem
Path and what we do not know

What it will not do

It does not set your price and it does not predict what the payer will offer. It compares positions and says which assumptions carry the answer.

It does not give legal or competition-law advice on contract terms. Your legal team reviews the terms.

It does not make the decision. The named decider does.

Scores and weights are analyst judgment from an AI specialist, not measurements. They show how the options compare on the criteria you chose; change the weights and the ranking can change.

It is one specialist’s answer. When you need several specialists to disagree in the open, run a Panel.

Facts the specialist could not source appear as gaps. Regulatory fees, review goals, reference prices and probabilities are cited to their sources or left open. Check any figure you will act on against its primary source.

References

[1] World Health Organization. WHO guideline on country pharmaceutical pricing policies, second edition. Announced 28 September 2020. Read from WHO’s announcement; the guideline text was not read in full.
[2] Council of the European Communities. Council Directive 89/105/EEC of 21 December 1988 relating to the transparency of measures regulating the prices of medicinal products for human use and their inclusion in the scope of national health insurance systems. Check the national rules that implement it.
[3] Garrison, L. P. Jr, Towse, A., Briggs, A. et al. Performance-based risk-sharing arrangements: good practices for design, implementation, and evaluation. Report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force. Value in Health, 2013;16(5):703–719. Read from the abstract; the full report is behind ISPOR’s login.
[4] Wenzl, M. and Chapman, S. Performance-based managed entry agreements for new medicines in OECD countries and EU member states: how they work and possible improvements going forward. OECD Health Working Paper No. 115, 2019. Known from the OECD publication page and search excerpts; not read in full.

Links checked 9 October 2026

These are the sources the template drew on. None of their authors or issuers has reviewed it.

About the Brief service

A Brief is a written answer from one specialist, at the depth you asked for. It arrives with its sources, and it closes by saying plainly what would change the conclusion. Nothing is hidden behind a summary, and anything the expert could not source is marked as a gap rather than filled in.

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